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Contaminated water and food, as well as mosquitoes, are the usual sources of discomfort in Nicaragua (and El Salvador). Always be careful about what you eat and insist on bottled water. As for those pesky mosquitoes, a good repellent with DEET should be enough to keep off bugs that bear unwanted gifts such as dengue fever and malaria. Go to www.cdc.gov for more specific info on malaria hot spots (usually rural areas). Vaccinations in general are not required, unless you are traveling from a yellow-fever zone. Nevertheless, you should always have up-to-date jabs for diphtheria, measles, tetanus, mumps, rubella, and polio. The CDC also advises travelers to vaccinate against Hepatitis A and B.

Before You Go

It can be hard to find a doctor you can trust when you're in an unfamiliar place. Try to take proper precautions the week before you depart to avoid falling ill while you're away from home. Amid the last-minute frenzy that often precedes a vacation, make an extra effort to eat and sleep well.

Pack prescription medications in their original labeled containers in your carry-on luggage. Also, bring along copies of your prescriptions in case you lose your pills or run out. Carry written prescriptions in generic form, in case a local pharmacist is unfamiliar with the brand name. If you wear contact lenses, pack an extra pair or your glasses.

If you worry about getting sick away from home, you may want to consider medical travel insurance.

If you suffer from a chronic illness, consult your doctor before your departure. For conditions such as epilepsy, diabetes, or heart problems, wear a MedicAlert identification tag (tel. 888/633-4298; www.medicalert.org), which will immediately alert doctors to your condition and give them access to your records through MedicAlert's 24-hour hot line.

Contact the International Association for Medical Assistance to Travelers (IAMAT; tel. 716/754-4883, or 416/652-0137 in Canada; www.iamat.org) for tips on travel and health concerns in the countries you're visiting, and lists of local, English-speaking doctors.

General Availability of Healthcare

Not surprisingly, most of Nicaragua's and El Salvador's best hospitals and healthcare centers are in the capitals, but service varies widely. If you do get sick, it's best to contact your home country's consulate or embassy. They all have health departments with staff who can recommend the best English-speaking doctors and hospitals in the area.

Common Diseases & Ailments

Dietary Distress -- It's unfortunate, but many travelers to Central America do suffer from some sort of food or waterborne illness. Most of this is just due to tender northern stomachs coming into contact with slightly more aggressive Latin American intestinal flora. Symptoms vary widely -- from minor cases of diarrhea to debilitating flulike illnesses. To minimize your chances of getting sick, be sure to always drink bottled or boiled water and avoid ice. In high altitudes, you will need to boil water for several minutes longer before it is safe to drink. If you don't have access to bottled water, you can treat it with iodine or chlorine, with iodine being more effective. You can buy water purification tablets at pharmacies and sporting-goods stores. You should also be careful to avoid raw food, especially meats, fruits, and vegetables. If you peel the fruit yourself, you should be fine.

If you do suffer from diarrhea, it's important to keep yourself hydrated. Many pharmacies sell Pedialyte, which is a mild rehydrating solution. Drinking fruit juices or soft drinks (preferably without caffeine) and eating salted crackers are also good remedies. In extreme cases of diarrhea or intestinal discomfort, it's worth taking a stool sample to a lab for analysis. The results will usually pinpoint the amoebic or parasitic culprit, which can then be readily treated with available over-the-counter medicines.

Typhoid fever is a food- or waterborne illness that occurs throughout Central America and is caused by salmonella. Long-term travelers should seriously consider getting a typhoid-fever vaccine before setting off, as the malaria-like symptoms are very unpleasant.

Hepatitis A is another viral infection acquired through water and food (it can also be picked up from infected people), this time attacking the liver. Usually the symptoms of fever, jaundice, and nausea will pass, but it can in some cases cause liver damage. There is an effective vaccine that you can take before the trip.

Tropical Illnesses -- Yellow fever is no longer a problem in Central America. However, if you are traveling from yellow-fever zones in South America or Africa you will require a vaccination certificate to enter Nicaragua and El Salvador.

Malaria does exist in Nicaragua and El Salvador, especially in rural areas. To protect yourself, use mosquito repellent with DEET, wear long-sleeved shirts and pants, and use mosquito nets. You can also take anti-malarial drugs before you go; consult your doctor about the pros and cons of such medications. Be sure to ask whether a recommended drug will cause you to be hypersensitive to the sun; it would be a shame to come down here for the beaches and then have to hide under an umbrella the whole time. Because malaria-carrying mosquitoes usually come out at night, you should do as much as possible to avoid being bitten after dark. Also, be aware that symptoms such as high fever, chills, and body aches can appear months after your vacation.

Dengue fever, transmitted by an aggressive daytime mosquito, is a risk in tropical environments and densely populated urban areas. As with malaria, the best prevention is to avoid mosquito bites; there is no vaccine available. Dengue is also known as "bone-break fever" because it is usually accompanied by severe body aches. The first infection with dengue fever will make you very sick but should cause no serious damage. However, a second infection with a different strain of the dengue virus can lead to internal hemorrhaging and could be life-threatening. If you are unfortunate enough to get it, take some paracetamol and lots of fluids.

Bees, Bugs & Bites -- Snakes, scorpions, and spiders rarely bite without provocation. Keep your eyes open and never walk barefoot. If you're in the jungle or rainforest, be sure to shake your clothes and check your shoes before putting them on. Africanized bees (the notorious "killer bees" of fact and fable) are common in this region, but there is no real danger of being attacked unless you do something silly like stick your hand into a hive. Other than mosquitoes, the most prevalent and annoying biting insect you are likely to encounter, especially along the coast, is sand flies. These tiny biting bugs leave a raised and itchy welt, but otherwise are of no significant danger. They tend to be most active around sunrise and sunset, or on overcast days. Your best protection is to wear light long-sleeved shirts and long pants.

The chances of contracting rabies while traveling in Nicaragua and El Salvador are low, but it's not completely impossible. Most infected animals live in rural areas. If you are bitten by an infected dog or bat, wash the wound and get yourself to a hospital as quickly as possible. There is a pre-vacation vaccine that requires three injections, but you should only get it if you are planning a high-risk activity such as cave exploring. Treatment is effective but must be given promptly.

Riptides -- Many of the Pacific coast beaches have riptides, strong currents that can drag swimmers out to sea. A riptide occurs when water that has been moved toward the shore by strong waves forms a channel back out to open water. These channels have strong currents. If you get caught in a riptide, you can't escape the current by swimming toward shore; it's like trying to swim upstream in a river. To break free of the current, swim parallel to shore and use the energy of the waves to help you get back to the beach. Note: Lifeguards are a rarity both here and in El Salvador.

Sunstroke -- Do not be a mad dog, nor an Englishman, for that matter. Do as the locals do and stay out of the midday sun. Your proximity to the equator means you burn much faster, and it's no accident that everybody escapes indoors between 10 a.m. and 2 p.m.. Hats and a SPF 30 (or higher) sunscreen are wise accessories, and if you do manage overdo it on the beach, drink lots of water and treat burns with aloe vera.

Safety

Nicaragua is the safest country in Central America and has somehow avoided the chronic gang violence so prevalent in Honduras and El Salvador. Nevertheless, there are some dangerous neighborhoods to avoid, especially in Managua and if you choose to get around on public buses; in frequently crowded places such as markets, watch your stuff, as pickpockets and bag snatchers might be tempted.

Staying safe is generally a case of common sense. Stay alert and be aware of your surroundings; don't walk down dark, deserted streets; and always keep an eye on your personal belongings. Keep your passport and credit cards on your person (but not stuffed in your back pocket). It's a good idea to keep separate money amounts, so if you are unlucky, you do not lose everything. Theft at airports and bus stations is not unheard of, so be sure to put a lock on your luggage.

Always report crime to the nearest police station or call tel. 118. It may take up some precious time, but your insurance claim will be useless without an official police report. The police are, in general, honest but poorly paid, so you may be solicited for some sort of multa (fine) or even just a simple contribution to pay for their gas. Taxis are the way to go at night, especially in Managua. However, single women travelers should avoid getting into cabs that have multiple passengers.

Note: This information was accurate when it was published, but can change without notice. Please be sure to confirm all rates and details directly with the companies in question before planning your trip.